Up to a third of men who opted for standard radiotherapy to treat their prostate cancer will suffer a recurrence of cancer. When the cancer returns, there are few options and many men have not survived after 5 years of initial treatment. Radical prostatectomy may be an option, but often the damage to the prostate from the original radiotherapy precludes this, and there are limited other options.

Radical prostatectomy often has significant consequences including lifelong incontinence and impotence, so the salvage focal therapy described has been compared with radical prostatectomy. The study has concluded that life extension with this therapy is equal to that of radical prostatectomy, but without the consequences.

Focal therapy treatments are regularly available in NHS centres, so these results can be applied immediately.

When twinned with SABR targetted radiotherapy, this offers a less invasive process for men hesitating with the potential devastating consequences of radical prostatectomy.

The post Salvage treatment for recurring prostate cancer after radiotherapy. first appeared on The Prostate Annals.

And the harms are real, with life-changing consequences for men and their partners which are all too often glossed over as ‘side-effects’. In too many cases the ‘cure’ will be worse than the disease. As many as 50% of diagnosed prostate cancers will not cause early death, but if treated will harm men unnecessarily. Of the other 50%, some will be helped by current treatments, but will still suffer life-changing consequences, and a very small number will have been diagnosed too late, or even present with a cancer so aggressive that no treatment can help.

So if there is an upside from this decision, it must be a renewed emphasis on less-radical treatments than those routinely offered, and research concentration on tracking down the root causes of the disease, designing immunisations to prevent it and treatments that empower the body’s own immune system to defeat it.

However, the committee recognised that particularly vulnerable groups with a genetic disposition should be routinely screened, and there is stronger evidence that may tip the balance towards the same screening for Black men, who are also more vulnerable to the disease.

It should also be noted that any man over 50 has a right to request a PSA test from their GP and certainly this must be more widely advertised to both patients with symptoms and GPs who are often reluctant to comply.

The post National Screening – the decision first appeared on The Prostate Annals.

You should have been told at some point in your radical prostate treatment to perform Kegel ( pelvic muscle ) exercises.

So what are they and what’s the point?

The surgery or radiotherapy you have received will have severely damaged tissues adjacent to your prostate and weakened the muscles on your pelvic floor that influence continence and potency You will be incontinent and impotent in some measure for some time, perhaps permanently. You can improve recovery times and/or reduce the effects of this trauma by carrying out pelvic floor exercises.

These are designed to strengthen these muscles, to provide support for your bladder and penile muscles to control continence and erections. The Squeezy app is recommended to impose a regular discipline on you to carry out the exercises at timed intervals and to record your progress.

Kegel Categories

There are 3 main categories of exercise, reflected in the squeezy app exercise routine.

The first is a clench and 10 second hold, followed by a 10 second controlled release. This is designed to provide strength to the muscles to enable long hold times.

Muscles are strengthened, be it biceps, abs or pelvics, by forcing micro tears in the muscle tissue which then heal during rest period, so it’s important to allow sufficient time between session for this to happen. The tears happen when muscles are over-stretched by loading, in this case, clenching hard. Slow relaxation allows the muscles to recover.

The second exercise is one or two seconds clench and the same time relax. This is to train the fast-twitch fibres of the muscles. The purpose of this is to deal with sudden stress incontinence when for example you sneeze, cough, change direction or get up suddenly and so on. This is the most frequent manifestation of post treatment incontinence that we experience.

The third exercise is a half-squeeze for a long (30 second or so ) duration. This is to encourage stamina in the muscles so you can contract your muscles for long periods.

Like all muscle-building, this takes time. You won’t see much progress for 2 or 3 months initially, then things should improve slowly as you continue.

The Knack

But there is no point in just strengthening if you don’t also apply it. So the fourth element is what is known as ‘the Knack’. This is training your body (and brain) to automatically invoke one of the above exercises according to circumstances. This is also the most difficult bit because it takes constant concentration .

So for example, if you feel a sneeze coming on you should simultaneously do the fast clench, if you get up from sitting, perhaps take a moment to start the slow clench and when you are just walking along, you may need to constantly half-squeeze.

In general, when you are sitting, lying or resting with your legs raised, gravity works for you and you don’t need to do anything, but it will be different for each individual.

Learning and using the Knack takes a long time, but you will improve and one day you will realise that you are doing it without thinking. As long as you keep the exercise regime going ( for the rest of your life) you may well find that you have conquered incontinence.

So, that’s the point of Kegels. It’s not easy but there is an achievable goal for most men. Using a pelvic floor physiotherapist specialist is worthwhile if you can afford it, for both progress measurement and encouragement. Good luck.!

The post What’s the point of Kegels ? first appeared on The Prostate Annals.

Erectile dysfunction following Robot Assisted Radical Prostatectomy (RARP) remains a major consequence of the surgery, with over 30% of men never recovering functional erections.

A new treatment is reported in the Journal of Sexual Medicine that includes the first electrically stimulated nerve treatment to induce erections post-surgery within a very short time.

The technique involves Low Intensity Electrical Stimulation (LIES) directly to the cavernosal nerves responsible for control of erection. These are often damaged during RARP and take many months to repair or recover, during which serious long-term damage to the penis can occur.

The study reports the first results using the CaverSTIM device, with 100% success in restoring normal erectile function, including nocturnal erections, in the small sample used.

Treatment consisted of a daily 1 hour session of LIES for 21 days, followed by daily 15 minute sessions at normal intensity.

The post Success for first implantable nerve stimulator for erectile function post-prostatectomy. first appeared on The Prostate Annals.

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This Guardian newspaper report gives more detail.

The post New AI test can predict which men will benefit from prostate cancer drug first appeared on The Prostate Annals.

80% of people exercising remained cancer-free compared with 74% in the other group meaning a 28% reduction in the risk of the cancer coming back, or a new one forming

https://www.bbc.co.uk/news/articles/c8xgyw7k7veo

The post Exercise ‘better than drugs’ to stop cancer returning after treatment, trial finds first appeared on The Prostate Annals.

Former U.S. President Joe Biden has announced he has been diagnosed with an aggressive form of prostate cancer. His team said the he had a gleason score of 9, and that it had spread to his bones. There is hope that the cancer is promoted by hormone presence and that it will respond to androgen treatment.

This is an example of the problem with late diagnosis. We might expect a U.S. President to have regular health checks, including PSA, Prostate exam and MRI checks. If he did and nothing was found, then the cancer has onset very quickly, and the prognosis is poor. It underlines the need for every man to get routine testing for prostate cancer, no matter his station or apparent state of health, and presses the need even further for better diagnostics, early treatment and research into prevention.

The post U.S. President Biden diagnosed with “aggressive” Prostate Cancer. first appeared on The Prostate Annals.

Da Vinci Robot provides surgeons with a less invasive radical prostatectomy option.

Link

The post Robotic surgery sees patient go home on same day first appeared on The Prostate Annals.

Easier screening testing is promised instead of a PSA blood test.

Link

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